Monday, February 27, 2012

If there’s an Estrogen Deficit, why not just give some?

OK, that’s a very good question. But it comes with a very complicated answer – not impossible, just complicated. The use of estrogen or, more accurately, estrogen and progesterone (Hormone Therapy or HT) must be individualized according to the treatment goals of the individual woman. The prescription cannot be standard because people aren’t standard. The relationship between benefit of therapy and risk of therapy isn’t the same for everyone and even changes for each individual as she changes with time, her needs, and her risks.

Benefits relate to symptoms and these can be very different among individuals. But therapy has the potential to help vasomotor symptoms (“hot flashes”), vaginal atrophy, difficulty with sexual relations, osteoporosis, and other problems that influence quality of life.

None of the benefits come without some risk or potential risks. These are related to the baseline disease risks (those the woman already has when menopause occurs or those she is more likely than others to develop), her age, age at menopause, cause of menopause, time since menopause, prior hormonal use, and medical conditions that do occur during treatment.

The “media” and regular people are very aware of some benefits that can be gained from HT, although knowledge is often sketchy and centers around the elimination of hot flashes to the exclusion of many other good things. But it is the risk of HT that provokes the generation of miles of newspaper columns and hours of videotapes. Almost all the risk discussion centers around breast cancer. There has been an enormous amount of discussion and debate about this complex topic, reflecting the differences in research information and academic opinion.

More posts will follow to discuss not only this issue, but also:

  • Vasomotor Symptoms
  • Vaginal Symptoms
  • Sexual Function
  • Urinary Function
  • Weight Osteoporosis
  • Cardiovascular Effects
  • Diabetes
  • Endometrial Cancer
  • Ovarian Cancer
  • Lung Cancer
  • Mood and Depression
  • Premature Menopause
  • Total Mortality
  • Hormone Treatment

Menopause is no small topic. Many issues and many millions of women are involved.

Monday, February 6, 2012

So Along Comes Menopause

After about 5 years of perimenopause the last period occurs. One year later women are defined as being in Menopause, usually at the age of 51 or 52.

One hundred years ago that just happened to be the same as life expectancy so the time spent in menopause was brief NOT ANYMORE.  Life expectancy is now up to 80 years for women in the United States; a third of their lives, about 30 years in menopause.  In 2010 there were 80 million women who were in menopause.  There is an enormous need to optimize those 30 years of life that women did not have 100 years ago.

The simply unifying cause in menopause is a Decline in Estrogen, an ovarian hormone.  This decline manifests itself in many different was throughout the body, some obvious and serious, and some vague are poorly understood.  Receptors to estrogen rise in many parts of t the woman’s body including not only the breast and urogenital tract, but also in the skin, liver, bone, brain, heart and gastrointestinal tract.  Probably the most commonly recognized effect of estrogen loss is the “Hot Flash”, among the conditions attributable to menopause, it is not life threatening or the cause of serious illness.  But it has large consequences.  In women aged 40 to 64 years, 63% report symptoms that are very bothersome.  These symptoms last, on average, 10 years.  A large percentage reports a negative impact on their daily lives.

Other problems associated with menopause take their toll, as well.  Heart disease, bone disease and urogenital conditions are a big problem.  Those issues will be addressed, along with therapeutic approaches, in follow up posts in the discussing menopause.